Association between antidepressant use during pregnancy and miscarriage: a systematic review and meta-analysis

Sophie Smith*, Flo Martin, Dheeraj Rai, Harriet Forbes

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background:
Literature surrounding the association between antidepressant use during pregnancy and miscarriage is conflicting. We aimed to conduct a systematic review and meta-analysis of studies among pregnant women regarding the association between exposure to antidepressants during pregnancy and the risk of miscarriage, compared with pregnant women not exposed to antidepressants.

Design:
We conducted a systematic review and meta-analysis of non-randomised studies.

Data sources:
We searched Medline, Embase and PsychINFO up to 6 August 2023.

Eligibility criteria and outcomes:
Case-control, cohort and cross-sectional study designs were selected if they compared individuals exposed to any antidepressant class during pregnancy to comparator groups of either no antidepressant use or an alternate antidepressant.

Data extraction and synthesis:
Effect estimates were extracted from selected studies and pooled using a random-effects meta-analysis. Risk of bias (RoB) was assessed using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool, and heterogeneity assessed using the I2 statistic. Subgroup analyses were used to explore antidepressant classes and the impact of confounding by indication.

Results:
1800 records were identified from the search, of which 29 were included in the systematic review and meta-analysis. The total sample included 5 671 135 individuals. Antidepressant users initially appeared to have a higher risk of miscarriage compared with unexposed individuals from the general population (summary effect estimate: 1.24, 95% CI 1.18 to 1.31, I2=69.2%; number of studies (n)=29). However, the summary estimate decreased when comparing against unexposed individuals with maternal depression (1.16, 1.04 to 1.31; I2=58.6%; n=6), suggesting confounding by indication may be driving the association. 22 studies suffered from serious RoB, and only two of the 29 studies were deemed at moderate RoB.

Conclusions:
After accounting for maternal depression, there is little evidence of any association between antidepressant use during pregnancy and miscarriage. Instead, the results indicate the biasing impact of confounding by indication.
Original languageEnglish
Article numbere074600
Number of pages10
JournalBMJ Open
Volume14
Issue number1
Early online date25 Jan 2024
DOIs
Publication statusPublished - 25 Jan 2024

Bibliographical note

Funding Information:
SS is supported by an NIHR predoctoral fellowship (NIHR301109). FM is supported by the Wellcome Trust (WT 218495/Z/19/Z). HF and DR acknowledge support from the NIH (1R01NS107607). This research was also supported by the NIHR Biomedical Research Centre at the University of Bristol and the University Hospitals Bristol and Weston NHS Foundation Trust.

Publisher Copyright:
© Author(s) (or their employer(s)) 2024.

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